SHM Converge Scientific Abstract ePoster Gallery-Ttp: Don't Yell Out Fat Rn!

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This case describes a 68-year-old woman with CKD stage IV and chronic iron deficiency anemia who was admitted for generalized weakness and found to be in hypovolemic shock. Her hospital course became complicated by a left MCA stroke, encephalopathy, and new-onset atrial fibrillation with rapid ventricular response. During the initial workup, she was noted to have new thrombocytopenia.<br /><br />TTP was not immediately recognized because the presentation was atypical and several findings pointed toward other causes. Her acute kidney injury was initially attributed to pre-renal azotemia from hypotension, and her anemia was difficult to interpret because of her chronic baseline iron deficiency. Although LDH and reticulocyte count were elevated, indirect bilirubin was only mildly elevated, haptoglobin remained normal, and the peripheral smear showed only a few schistocytes. Her PLASMIC score was 5, suggesting only a moderate risk of severe ADAMTS13 deficiency.<br /><br />Despite these less convincing features, her thrombocytopenia worsened and neurologic status failed to improve after stabilization of shock and atrial fibrillation. Because of increasing concern for TTP, plasmapheresis was started on hospital day 5. On day 8, ADAMTS13 activity returned at 5%, confirming the diagnosis. After five rounds of plasmapheresis, her platelet count improved to 180,000 and hemolysis markers improved.<br /><br />The key lesson from this case is that TTP can present atypically and may not show the classic pentad or dramatic hemolysis findings. Clinicians must integrate symptoms, laboratory data, and scoring tools such as the PLASMIC score, but also maintain a high index of suspicion so treatment can begin promptly before confirmatory ADAMTS13 results return.

Asset Subtitle

Nadim Islam

Meta Tag

Author List Christine J. Kang, Nadim Islam

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Hematologic Emergency

Concept Empiric Treatment

Concept Thrombocytopenia

Concept Total Plasma Exchange

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center at Tyler Internal Medicine Program

Presenting Author Nadim Islam

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

ADAMTS13 deficiency

plasmapheresis

thrombocytopenia

hemolytic anemia

PLASMIC score

stroke

encephalopathy

atrial fibrillation

Thrombotic Thrombocytopenic Purpura

Hematologic Emergency

Empiric Treatment

Thrombocytopenia

Total Plasma Exchange